POLICY
Effective Date:
January 1, 2000
Date Issued:
December 1, 1999
Date Approved by Board of Directors: September 3, 1999
NUMBER:1.2.1A
Topic: Guidelines for Automatic
Assumption – Injuries on
or after January 1, 2000
Section: Entitlement
Subsection: Occupational Diseases
POLICY STATEMENT
1. Section 35 of the Workers' Compensation Act states:
"Any coal miner who a) has worked at the face of a mine or in similar conditions twenty years or
more; and b) suffers from a permanent impairment that is a loss of lung function, shall be compensated
according to the permanent impairment as calculated pursuant to Section 34."
2. The Board has defined that the expressions:
2.1 "Any coal miner who has worked at the face of a mine... twenty years or more" means any
coal miner who is/was employed by a coal company and works/worked underground for a period
of twenty years or more;
2.2 "similar conditions" applies to coal miners who are/were employed by a coal company and
works/worked at the wash plant, at or near the bankhead or on the shipping/coal piers.
3. The Board further directs:
3.1 that new applicants who qualify under Section 35 will need completed Forms 67, and 8 to open a
claim;
3.2 that once a claim has been opened, an appointment for a lung function test will be arranged and
interpreted using the following pulmonary function guidelines:
Class
Obstructive Disease FEV1 /
FVC (%) *
1. No Disability
greater than 70%
2. Mild Disability
10% Award
60-70%
3. Moderate Disability
20% Award
55-60%
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Policy Number 1.2.1A
Guidelines for Automatic Assumption – Injuries on or after January 1, 2000
4. Severe Disability
35% Award
50-55%
5. Very Severe Disability
60% Award (Automatic Review by Physician)
less than 50%
Class
Restrictive Disease Vital
Capacity (%) Predicted *
1. No Disability
greater than 85%
2. Moderate Disability
20% Award
75-85%
3. Severe Disability
35% Award
60-75%
4. Very Severe Disability
60% Award (Automatic Review by Physician)
less than 60%
* These are measurements of lung capacity. Lower numbers indicate a greater loss of lung
function.
3.3 that an applicant who has been examined by lung function testing, whether allowed or disallowed,
shall be recalled as soon as possible after three years have elapsed from the date of the applicant's
last test for Automatic Assumption, unless medical evidence justifies an earlier re-examination;
however, the Board strongly recommends that each applicant undergo a chest x-ray for his/her
own personal health. These x-rays may be requested by the applicant's family doctor and
reported on a Form 8;
3.4 that applicants who have previously made a claim that was allowed or disallowed will not be
required to fill out new forms but will be obligated to keep the W.C.B. informed of any changes
affecting their file;
3.5 that new applicants who do not qualify under Section 35 will be processed under our normal
procedures;
3.6 that where an applicant is unable to obtain his/her work record, a sworn affidavit before a
commissioner of the Supreme Court of the province is the only accepted document.
General Claims – Pneumonoconiosis
4. The provisions covering the general type of pneumonoconiosis claims are set out in Sections 13 and
14, inclusive, of the Statute.
5. The following guidelines as to procedures, handling and adjudication of such claims are established,
subject to the fact that each claim, finally, has to be considered on its own merits or on any
characteristics or elements peculiar to a particular claim or worker.
5.1 For each new pneumonoconiosis claim opened, the W.C.B. Administrator of Medical Services
reviews the claim file along with the local chest films that are sent in. If the Administrator of
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Policy Number 1.2.1A
Guidelines for Automatic Assumption – Injuries on or after January 1, 2000
Medical Services feels there is sufficient radiological evidence to make a diagnosis of
pneumonoconiosis, the client is put on the list to be called in for full examination by a chest
specialist.
If, however, the Administrator of Medical Services does not feel there is sufficient evidence to
make a diagnosis of pneumonoconiosis, the x-rays, along with the work history of the client, are
referred to two independent specialists for readings. If either one of these specialists feels there is
sufficient evidence to warrant a diagnosis of pneumonoconiosis, then the client is brought in for
full examination, which includes a complete clinical assessment along with pulmonary function
tests and further chest x-ray examination. If both specialists agree that there is not sufficient
evidence to warrant a diagnosis of pneumonoconiosis, then the claim is officially disallowed at
that time.
5.2 Pulmonary Function Testing will be used to determine the existence and degree of a worker’s
permanent impairment rating, using the American Medical Associations “Guidelines to the
Evaluation of Permanent Impairment – Fourth Edition” (the “AMA Guidelines”).
5.3 On receipt of the two specialists' reports concerning either x-ray assessment or examination
assessment, the Administrator of Medical Services puts forth the opinions and recommendations
of these reports to the Claims Adjudicator who make the final decision on the claim. In some
cases, additional medical information, etc. must be obtained before a final recommendation can
be made.
Calculations for Automatic Assumption Costs
6. In the case of a miner who qualifies for Automatic Assumption and has worked for more than one
employer, the mine where the miner worked the longest, that is, the total number of years employed
under the conditions as set forth above, will be charged the amount for all funds expended, medical
aid, pensions, etc.
APPLICATION
This Policy applies to injuries arising on or after January 1, 2000.
REFERENCES
Workers’ Compensation Act (Chapter 10, Acts of 1994-95) (as amended), Sections 13, 14, 35.
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